Adult

There are two main types of adult scoliosis – pre-existing (usually adolescent scoliosis), which becomes known as Adolescent Scoliosis in Adult (ASA); and the development of a new scoliosis, usually as a result of spinal degeneration.
This is known as Degenerative De-Novo Scoliosis (DDS).

Adults with ASA may or may not have previously been diagnosed with adolescent scoliosis. ASA may be progressive or stable, depending on the individual case. In those with a previous diagnosis of AIS monitoring progression is easy as comparison of current x-rays to adolescent x-rays can be done. In those where the scoliosis is discovered in adulthood, determining if the scoliosis is a pre-existing adolescent condition or a new onset of degenerative scoliosis can be difﬁcult.

DDS usually develops in middle aged and older adults and is typically seen starting around 45 years of age onwards. Because DDS is a result of degenerative instability, it is almost always progressive. However the main complaint usually associated with DDS is lower back pain.

Pain and adult scoliosis

Although some forms of adult scoliosis can be progressive, the main complaint is usually lower back pain. Often this pain is severe and little relief has been found from usual medical and complementary care. A common misunderstanding still perpetuated by most health professionals is that scoliosis does not cause pain. This is not true. This notion has come about because the majority of children suffering from adolescent idiopathic scoliosis do not present with a primary complaint of pain and quite often even large deformities in children do not cause pain. However, in adults between the ages of 50 and 80 who suffer from chronic lower back pain, research shows that up 40% will have an adult scoliosis.
This misconception has led to a diagnostic and treatment approach that largely ignores the role of scoliosis in chronic lower pain in adults and, as a result, less than satisfactory outcomes for many of these patients.

The pain seen in adult scoliosis is not related to the size of the curve. Several good studies show there is little to no relationship between the size of the curve and pain. i.e a 20 degree and a 55 degree curve have the same chance of causing pain in an adult.

There are two key factors related to pain in adults

Location of the curve. Almost all complaints of pain in adult scoliosis are of lower back pain. The majority of new DDS curve are lower back curves. It is rare for a single curve in the upper spine to cause lower back pain. However in some cases patients with ASA who have an “S” shaped curve, the bottom half of the curve in the lower back may cause pain as an adult.
Balance of the spine. What is meant by “balance” is the forward/backwards, left right/shift of the spine that does not necessarily related to the size of the curve. Most importantly adults with scoliosis who have a forward shifted posture, or those that are bent forward, will develop more pain than those in a neutral or backwards shifted posture.

Treatments for adult scoliosis

The usual care recommended for patients suffering back pain with adult scoliosis is pain killers, anti-inﬂammatory or other drug treatments, back strengthening exercises, surgical decompression and the whole range of other medical and complementary treatments used to treat common lower back pain. On the whole these treatments do not manage the pain over the medium to long term as they generally do not help to treat the underlying condition causing the pain, which is the scoliosis.

Specialised conservative scoliosis treatments and specialised surgical treatments have been developed to treat adult scoliosis. Unfortunately as adult spines have ﬁnished growing, the potential to make correction is limited to the inherent ﬂexibility of the scoliosis and is usually very limited. However in many cases, the scoliosis need not be corrected to reduce pain. As the majority of adult scoliosis patients suffering pain do so because of the altered spinal balance and not because of the size of the curve, both conservative and surgical treatments that specialise in treating adult scoliosis can be beneﬁcial.

In some cases, pain relief and stabilisation can be achieved with intensive specialist physiotherapy which works on spinal balance, not just strengthening core muscles. The goal of these programs is to teach the patient to overcorrect the abnormal position the scoliosis causes in their posture. Once the patient can make these correction movements, there a series of exercises can be used to re-enforce the correction and assist the body to maintain the correction itself.

Specialised scoliosis specific exercise programs play an important role in the treatment of scoliosis in adults. Traditionally there has been the opinion that “exercise does not work for scoliosis”. While this is true for general exercise (eg. core stabilisation, pilates) there are now specialised scoliosis speciﬁc exercise programs that are supported by published evidence and are regarded as effective when delivered by certiﬁed providers.

ScoliBalance is a specialised scoliosis specific exercise program that is tailored to each individual patient according to their curve type, symptoms and treatment goals.

By focusing on improvements in spinal balance, ScoliBalance is effective at reducing back pain in the majority of scoliosis cases. If the curve is flexible, it may also be possible to achieve improvement to body appearance. ScoliBalance may also improve standing balance and reduce fall risk in older adults. While ScoliBalance is very helpful in pain management, it may also aid in slowing the progression of a degenerative curve. However where degenerative progression is present, an adult custom 3D brace should be recommended.

Bracing has been used as an early intervention treatment for scoliosis for decades. Over the years the way that scoliosis braces are designed and manufactured has evolved.

Adults with scoliosis present in a variety of different goals of treatment.

In elderly adults with degenerative scoliosis, low back and leg pain are often the main complaint regarding their scoliosis. In these cases the spine may have some instability in the form of lateral listhesis. Bracing can be very effective in stabilizing the spine and reducing pain.

In younger adults, cosmetic and postural complaints are often the main issue. In these cases the 3D corrective nature of the ScoliBrace has the best chance at improving the postural cosmetic concerns.

Performing surgery on adults can be challenging and carries higher risks. This is particularly true when the patient has osteoporosis, which weakens the bones and makes it harder to attach rods and bone grafts. Although surgery may not always provide pain relief, it may be the only viable option when conventional and conservative treatments have been unsuccessful.